全甲狀腺切除術中保留副甲狀腺功能的策略

Strategies of Preserving Parathyroid Function During Total Thyroidectomy

施佑蓁(Yu-Chen Shih) ； 陳慧君(Hui-Chun Chen) ； 陳秀雅(Hsiu-Ya Chen) ； 張碧瑩(Pi-Ying Chang) ； 吳哲維(Che-Wei Wu) ； 江豐裕(Feng-Yu Chiang)

《台灣耳鼻喉頭頸外科雜誌》 48卷1期 (2013/03) Pp. 79-86

https://doi.org/10.6286/2013.48.1.79

摘要

BACKGROUND: Permanent hypocalcemia after total thyroidectomy is a severe complication. The goal of this study was to investigate the reliability of parathyroid capsular incision for the determination of the status of the parathyroid bloodsupply and for the facilitation of the functional parathyroid preservation. Whether autotransplantation of at least one parathyroid eliminates permanant hypocalcemia was also investigated.METHODS: Between January 2009 and June 2012, 272 patients underwent total thyroidectomy were divided to two groups: group A, 64 patients without parathyroid autotransplantation but with at least one vascularized parathyroid gland; group B, 208 patients with at least one autotransplanted parathyroid gland. The incidence of temporary and permanent hypocalcemia after total thyroidectomy were documented and analysed.RESULTS: The incidence of temporary and permanent hypocalcemia were 9.4% and 0% in group A, and 34.1% and 1% in group B. Group A patients had a significantly lower incidence of temporary hypocalcemia than group B patients (p ＜ 0.001). Group B patients with more autotransplanted parathyroid glands had a significantly higher incidence of temporary hypocalcemia (20.4% vs. 64.3%, p ＜ 0.001).CONCLUSIONS: Our results suggest that the best strategy to preserve parathyroid function is to preserve the vascularized parathyroid in situ. Parathyroid capsular incision is a simple, safe and reliable method to determine the status of the parathyroid bloodsupply. Parathyroid autotransplantation may reduce but not eliminate the incidence of permanent hypocalcemia and should be indicated selectively for devascularized parathyroid glands instead of routine adoption.

關鍵字

副甲狀腺自體移植 ； 全甲狀腺切除術 ； 低血鈣

並列摘要

BACKGROUND: Permanent hypocalcemia after total thyroidectomy is a severe complication. The goal of this study was to investigate the reliability of parathyroid capsular incision for the determination of the status of the parathyroid bloodsupply and for the facilitation of the functional parathyroid preservation. Whether autotransplantation of at least one parathyroid eliminates permanant hypocalcemia was also investigated.METHODS: Between January 2009 and June 2012, 272 patients underwent total thyroidectomy were divided to two groups: group A, 64 patients without parathyroid autotransplantation but with at least one vascularized parathyroid gland; group B, 208 patients with at least one autotransplanted parathyroid gland. The incidence of temporary and permanent hypocalcemia after total thyroidectomy were documented and analysed.RESULTS: The incidence of temporary and permanent hypocalcemia were 9.4% and 0% in group A, and 34.1% and 1% in group B. Group A patients had a significantly lower incidence of temporary hypocalcemia than group B patients (p ＜ 0.001). Group B patients with more autotransplanted parathyroid glands had a significantly higher incidence of temporary hypocalcemia (20.4% vs. 64.3%, p ＜ 0.001).CONCLUSIONS: Our results suggest that the best strategy to preserve parathyroid function is to preserve the vascularized parathyroid in situ. Parathyroid capsular incision is a simple, safe and reliable method to determine the status of the parathyroid bloodsupply. Parathyroid autotransplantation may reduce but not eliminate the incidence of permanent hypocalcemia and should be indicated selectively for devascularized parathyroid glands instead of routine adoption.

並列關鍵字

parathyroid autotransplantation ； total thyroidectomy ； hypocalcemia